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Stroke at high altitude: Garhwal region, north India

Author: 
Dr. Murali Mohan, K. T. K., Dr. Monica, P., Dr. Butola, K. S., Dr. Leena, P. and Dr. Avinash, K. S.
Subject Area: 
Health Sciences
Abstract: 

Background: Sir Veer Chandra Singh Garhwal Government Institute of Medical Sciences and Research Centre is a tertiary referral Centre for Eastern Garhwal Region which caters to the medical needs of Chamoli, Rudraprayag and Pauri-Srinagar Districts of Uttarkhand, North India. H.N. Bahuguna Government Base Teaching Hospital is attached to the above institution is located near Srinagar town in the Alakananda Valley at 579 meters above the sea level. The patients who are referred here come from Kedarnath and Badrinath valleys lying at an altitude of 1500 to 3500 meters above the sea level. Aims and Objectives: This is an observational study undertaken to study the clinical presentation, risk factors, neurological presentation, pattern of brain strokes, areas of brain affected as per CT scan findings in the adult population coming from the high altitudes of Eastern Garhwal region of Uttarkhand State in North India during the period from January to December 2013.Materials and Methods: All the adult admitted cases in the hospital were examined clinically for hypertension, Diabetes and systemic and neurological examination were conducted followed by laboratory investigations, which included routine urine and blood examination, ECG, X-Rays, CT-Brain plain and contrast and CSF analysis, when indicated. Observations: Out of the 336 cases of stroke studied during the period from 1st January 2013 and to 31st December 2013 in our hospital, 61.3% were having hypertension, 20.5% were smokers, 10.11% were having diabetes mellitus, and 7.44% were having cardiac disease. Over all incidence of stroke was 28/100,000 population with male to female ratio 7:4. Clinically, unilateral weakness was seen in 58.6%, unilateral sensory impairment in 19.9%, conjugate deviation of eyes in 16.4%, impaired cognitive function 37.2%, impaired consciousness in 21.4%, aphasia in 13.4%, dysphasia in 19.6%, dysphagia in 11.6%, dysarthria in 27%, ataxia in 5.4%,headache 16.1%,vertigo in 8.6%and seizures 12.5%. Ischemic infarctions were 58.65%, hemorrhages were 25.89%, transient ischemic attacks were 12.5%, subarachnoid hemorrhage were 1.78% and cortical vein thrombosis 1.91% as revealed by CT scans reports. Recurrent strokes were 5.95%. Mortality in the study was 8.3%.

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